Kingsborough Community College Of the City University of New York Department of Nursing

ST 5 – Advanced Surgical Procedures V Course Syllabus: Spring Semester 2018 Prerequisites: ST 4, ST4P Credit Hours: 4 Pre/Corequisites: Bio 51 Class Time: Monday/Wednesday 8-10:10 am Corequisite: ST5P

Instructor: Jorge A. Zamudio MS, CST Office: M417 Email: [email protected]; Phone: 973-945-7822 Office Monday: 11:00 pm to 2:00 pm Hours: Wednesday: 11:00 pm to 2:00 pm

Catalogue Description This is an orientation to specific surgical specialties including plastic, ophthalmic, vascular, orthopedic, neurosurgery, thoracic and cardiac . This course intends to introduce the student to advanced surgical procedures with focus on system review, pathology, purpose in conjunction with those, techniques utilized during such specialties. Specialized instrumentation and surgical modalities of each Surgical Specialty will also be covered as it relates to the practice of Surgical Technology. In addition, Trauma and Transplant considerations will be discussed.

Course Overview This course will give the student the opportunity to acquire knowledge of the more complex surgical specialties considering the pathology and goals associated surgical interventions. It will be taught as a 4-hour weekly lecture in conjunction with Practicum III, which will provide an active hands-on component. The principles will be integrated with the practices at all times with clinical experience in the hospital setting.

Student Learning Outcomes Upon successful completion of this course, the student will:

Student Learning Outcomes Assessment Measures 1. Discuss the relevant anatomy related to Students will successfully answer examination questions related plastic, pediatric, ophthalmic, vascular, to the normal anatomic systems of each unit. This includes orthopedic, neurosurgery, thoracic and and blood supply as well as type of surgical approach. cardiac surgery. 1. Describe the pathology that prompts Students will successfully answer examination questions related surgical intervention. to the pathology affecting each anatomical system that would require surgical intervention. 2. Discuss preoperative diagnostic tests and Students will successfully answer examination questions related preparations. to the preoperative preparation of patients requiring surgical interventions for each anatomical system. 3. Identify the names and uses of Students will demonstrate a working knowledge of the instruments, supplies and drugs pertinent instruments, supplies and medications related to the surgery for to that body system, each anatomic system by successfully answering test questions as well as submitting weekly homework assignments. 4. Identify the names and uses of specialized Students will recall the appropriate types of equipment specific equipment for that system. to each anatomic system by successfully answering test questions related to those systems. 5. Define and discuss advanced surgical The students will answer test questions, submit homework and procedures. writing assignments to demonstrate an understanding of the surgical procedures related to each anatomic system.

1 6. Discuss the expected outcomes of the The students will answer test questions and submit homework surgical intervention. assignments that identify the outcomes of each surgical procedure for the anatomic system. 7. Discuss the postoperative care and The students will answer test questions and submit homework possible complications. assignments that identify the postoperative care and possible of each surgical procedure for the anatomic system.

Topical Outline Unit 1 Plastic and Hand Surgery Unit 2 Pediatric Surgery Unit 3 Ophthalmic Surgery Unit 4 Neurosurgery Unit 5 Orthopedics Unit 6 Vascular Surgery Unit 7 Thoracic Surgery Unit 8 Cardiac Surgery Unit 9 Trauma Surgery Unit 10 Emergency Procedures Unit 11 Transplant Surgery

Teaching Strategies Lecture Teacher-guided discussion Audio-visual materials Demonstration/Return demonstration Required Textbooks  Fuller, Joanna K., Surgical Technology: Principles and Practice, 6th Edition, Elsevier  Goldman, Maxine A., Pocket Guide to the Operating Room, 3rd Edition, F.A. Davis

Recommended Textbooks  Meeker, Margaret H. and Jane C. Rothrock, Alexander’s Care of the Patient in Surgery, Mosby, St. Louis, Missouri,13th Edition, 2007  Thomas, L. Clayton, Taber’s Cyclopedic Medical Dictionary, F.A. Davis Company, Philadelphia, Pennsylvania, 20th Edition, 2006

Attendance Since attendance and punctuality are a key requirement for all Surgical Technologist in an Operating Room, neither is acceptable without proper documentation as to the reason for either the absence or the lateness. A student is deemed excessively absent when he or she has been absent 15% of the number of contact hours a class meets during a semester. When a student is excessively absent, a grade of “W” or “WU” will be assigned as described in the college catalog.

Health Clearance Students are required to have health clearance and evidence of CPR training prior to registration. Malpractice insurance is not covered by the college. During the semester any change in the student’s health clearance (e.g., serious illness, accident, pregnancy, etc.) necessitates evaluation by student health service. Student responsibility includes notification of the instructor and course coordinator. Health clearance must be maintained to continue course enrollment.

Grading Scheme

A+ 98-100 B+ 88-89 C+ 78-79 D+ 68-69 F 59 and below A 95-97 B 85-87 C 75-77 D 65-67 W Withdrew without penalty A- 90-94 B- 80-84 C- 70-74 D- 60-64 WU Unofficial Withdrawal (Counts as failure) * INC Term’s Work Incomplete. Counts as “F” grade unless work is completed within six months. * The minimum passing grade required for a surgical technologist course (SUR) is a C+ (75%); any grade below a C (75%) is a failing grade. Refer to the Surgical Technologist Student Handbook for academic progression and grading criteria.

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Assessment Criteria

% of Assessment Type # Description Grade Final Exam 1 Final Written Exam 30% Unit Exams 7 End of Unit Tests 60% Quizzes 10 Terminology 1% each 10%

Course Policies The Department of Nursing adheres to the Policies and Procedures on Academic Integrity as set forth by CUNY. See the Surgical Technology Student Handbook, the KCC Catalog and website for further details.

Classroom Decorum All pagers, wireless phones, electronic games, recording devices, radios, tape or CD players or other devices that generate sound must be turned off when any member of the academic community enters a classroom. Cellular devices are not allowed to be used during class time. Ear buds, or head phones are not allowed in the classroom. Hats, hood and scarves are to be removed when entering the classroom for both lecture and lab. Members of the academic community must exit the classroom to make or receive calls. Leaving the classroom to answer a phone call or use the bathroom is disruptive to the flow of the lecture; therefor re-admittance will be subject to the instructor’s discretion.

Homework Assignments All written assignments must comply with college standards for written work. Written assignments are to be turned in during the class period on the date that they are due. All assignments must be handed in by the end of the course to complete the requirements of the course. A late assignment will meet the requirements of the course but will not receive full credit. Assignments that are turned in after the assigned due dates will receive a 5 point deduction for each late day after the actual grade was granted. If written assignments are not submitted by the end of the course, the student will receive a grade of “0” for the assignment. All homework is to be hand written, submitted on paper on the due date and must reflect student’s original work. Photo copies and in-class USB/ or emails will not be accepted. Printing should be completed at home or in a college computer lab. A conference with the instructor is required at mid-semester and at the end of the course to discuss the student’s progress. Students may initiate conferences at other times.

Makeup Policy Students are expected to take all tests when scheduled. For unforeseen circumstances exceptions will made and faculty must know in advance. Students who do not take a test on the scheduled date are required to take a makeup test. All makeup tests will be given at the end of the semester on the same day of the final exam. Students who fail to take the scheduled exams or makeup will receive a grade of zero for that test.

CRITERIA FOR RETENTION IN THE SURGICAL TECHNOLOGY PROGRAM Receive no more than two grades below “C” in any of the required courses. Earn a minimum grade of “C” in all Surgical Technology Courses. Students earning less than a “C” grade in a Surgical Technology Course may repeat the course one time. The minimum grade for a repeated course is a “B.” A second earned grade of less than “C” in any Surgical Technology course will result in dismissal from the Program. Students achieving a grade of less than “C” in any clinical course must apply in writing, no later than June 15th for re-entry in the next ST class. Students must submit an “Intent to Return to Nursing/Surgical Technology Program” form outlining what they thought caused them to be unsuccessful and include a plan for success that demonstrates significant changes in how they will approach the course. Readmission is subject to space availability and is not guaranteed. This form may be found on the Nursing Department website.

Fatigue Fatigue can certainly impair a health care worker’s ability to provide safe, professional case. Thus KCC’s Nursing Department states: All students need to carefully assess his/her level of fatigue, school requirements in terms of lecture, on-campus labs and clinical experiences and own work schedules. This assessment should carefully consider the potential impact of excessive employment on his/her ability to provide safe, professional care. Each student has an ethical responsibility to ensure that fatigue does not negatively impact student responsibilities. 3

Netiquette Be mindful that electronic communication does not convey facial expression or tone of voice. It is important to consider what is written could be misinterpreted. Typing messages all in caps is regarded by most internet uses as shouting; so unless you mean to yell at someone, type your message in standard format. It is appropriate to share your point of view as well as indicate disagreements with another’s posts- however. It is not okay to make negative personal statements about another’s posts. Since many people read their email on small screen devices, when appropriate, be brief. Clearly indicate the nature of your email messages. It you send an email from a personal email account, sign the message. Often the names of personal email accounts are different from a person’s given name. Use the KCC email whenever possible.

COURSE CALENDAR

Unit 1 and Hand Surgery Learner Objectives Content/Lecture Discussion Related Learner Assignments and Experiences Evaluation Due Dates Syllabus review and course - Introduction WEEK 1 requirements - Anatomy Mon. 03/05- Wed. 03/07 - Instrumentation Aesthetic/cosmetic procedures Reading Assignment: - Fuller 6th ed. Plastic surgery - 737– 760, Upon completion of this - Dermabrasion Hand surgery 810-814 unit the student shall be able - to: - Augmentation mammoplasty Recommended Reading: 1. Discuss the role of the - Reduction mammoplasty Goldman, Maxine A., Pocket surgical technologist as it - . Guide to the Operating Room relates to Plastic Surgery. - Mentoplasty - Rhytidectomy - Full thickness graft (FTSG) - Scar revisions - Split thickness skin grafts (STSG) - Flaps - Tissue explansion - Cheiloplasty - Palatoplasty - Contracture release - - Debridement Hand Surgery - Carpal/metacarpal arthroplasty - Carpal tunnel release - Ganglion excision - Palmar fasciectomy - Release of trigger finger - Syndactyly release - Nerve repair/graft - Tendon repair/graft - Reimplantation procedures

Unit 2 Pediatric Surgery Learner Objectives Content/Lecture Discussion Related Learner Assignments and Experiences Evaluation Due Dates Upon completion of this Most Common Pediatric Procedures WEEK 2 Mon. 03/12 unit the student shall be - tracheoesophageal fistula Mon. 03/12 – Wed. 03/14 Terminology QUIZ # 1 able to: - biliary atresia Reading Assignment: Plastic Surgery 1. Discuss the role of the - intestinal atresia Fuller, P 930- 965 surgical technologist as it - imperforate anus 4 relates to Pediatric - diaphragmatic hernia repair Handout: Surgery. - excision of cystic hygroma Outline for pediatric - pyloromotomy procedures. - omphalocele repair - gastroschisis repair - reduction of intussusception - derortation of volvulus - colon resection for Hurschsprung’s disease - bladder exstrophy repair

UNIT 3 Ophthalmic Surgery Learner Objectives Content/Lecture Discussion Related Learner Assignments and Experiences Evaluation Due Dates Upon completion of the 1. Eyelid procedures WEEK 3 Mon. 03/19 unit the student will be - ectropian/entropian repair Mon. 03/19 – Wed. 03/21 EXAM # 1 able to: - levator resection Plastics/Pediatrics 1. Discuss the role of the 2. Strabismus procedures Reading assignment: surgical technologist as it - recession, resection Fuller, P 652-684 Terminology QUIZ # 2: relates to those 3. Corneal procedures Instruments 660-665 Pediatric Surgery procedures of the eye. - keratoplasty/corneal transplant - radial keratotomy Recommended Reading: 4. Lens Procedures Goldman, Maxine A., Pocket - intracapsular cataract extraction Guide to the Operating Room - extracapsular cataract extraction - phacoemulsification - placement of intraocular lens 5. Retinal Procedures - cryotherapy - scleral buckling 6. Vitreous Procedures - anterior vitrectomy - posterior vitrectomy 7. Glaucoma Procedures - iridectomy - trabeculectomy - placement of drainage shunt 8. Miscellaneous - excision of pterygium - excision of chalazion - lacrimal duct probing - dacrocystorhinostomy - enucleation, orbital exenteration

UNIT 4 Neurosurgery Learner Objectives Content/Lecture Discussion Related Learner Assignments and Experiences Evaluation Due Dates Upon completion of the unit 1. Cranial Procedures WEEK 4 Mon. 03/26 the student will be able to: - trephination Mon. 03/26 – Wed. 03/28 EXAM # 2 1. Discuss the role of the - craniectomy Reading assignment: Ophthalmology surgical technologist as it - craniotomy Fuller 6th ed., P 966-1019 relates to neurosurgery. * aneurysm Instruments, P 231-247 Terminology QUIZ # 3 * tumor Ophthalmic Surgery - cranioplasty - ventricular shunting Recommended Reading: - transphenoidal hypophysectomy Goldman, Maxine A., Pocket - stereotactic procedures Guide to the Operating Room

2. Spinal Procedures 5 - cervical fusions - lumbar laminectomy - spinal fusion’ - percutaneous discectomy - chemoneucleolysis - cordotomy/rhizotomy

3. Peripheral Nerve Procedures - median nerve exploration - ulnar nerve transpostion

UNIT 5 Orthopedic Surgery Learner Objectives Content/Lecture Discussion Related Learner Assignments and Experiences Evaluation Due Dates Upon completion of the  Anatomy review: types of Joints WEEK 5 Mon. 04/09 unit the student will be (synarthrosis, amphiarthrosis, Mon. 04/09 – Wed. 04/11 EXAM # 3: able to: synovial or diarthrosis, ball and Neurosurgery 1. Discuss the role of the socket joint), anatomical Reading assignment: surgical technologist as it movements, tendons and Fuller, P 761-835 Terminology QUIZ # 4: relates to orthopedic ligaments. Instruments, P 231-247 Neurosurgery procedures.  Main considerations for case management: diagnostic procedures, patient transport and Recommended Reading: transfer, positioning, orthopedic Goldman, Maxine A., Pocket or fracture table positioning, Guide to the Operating Room positioning devices, hemostatic agents, control, dressings, pneumatic tourniquet  Fracture management: type of fracture and patterns: classification of fractures, biomechanical forces on bone, reduction or fracture Repair, types of reductions (open, closed), traction and Distraction, facture fixation (internal, external), fracture management, internal fixation devices, surgical options for fixation, compartment syndrome, bone healing process.  Orthopedic instrumentation and equipment, technology, implants (screws, plates, nails, joint replacements), bone grafts, cement  Casting Technique  Types of traction

1. Fracture management - types of fractures - bone healing ______- closed reduction/casting - external fixation WEEK 6 Mon. 04/16 - open reduction/internal Mon. 04/16 – Wed. 04/18 Terminology QUIZ # 5: fixation Finish Ortho Orthopedic Surgery - prosthetic replacement - treatment of non-union

2. Shoulder Procedures - arthroscopy 6 - rotator cuff repair - humeral head arthroplasty - total shoulder replacement

3. Upper limb Procedures - elbow arthroplasty - total elbow replacement - total wrist replacement 4. Hip Procedures - Fixation of femoral head fractures - total hips arthroplasty 5. Lower Limb Procedures - epiphydesis - fractures 6. Knee Procedures - arthroscopy - Meniscectomy - anterior collateral ligament repair - total knee replacement 7.Ankle/Foot Procedures - arthroscopy - arthrodesis - malleolar fracture - total ankle replacement - triple arthrodesis - bunionectomy - correction of hammer toe 8. Miscellaneous - amputation - disarticulation - osteotomy - tendon procedures

UNIT 6 Vascular Procedures Learner Objectives Content/Lecture Discussion Related Learner Assignments and Experiences Evaluation Due Dates Upon completion of the unit 1. Dialysis Procedures WEEK 7 Mon. 04/23 the student will be able to: - arteriovenous fistula Mon. 04/23 – Wed. 04/25 EXAM # 4 1. Discuss the role of the - arteriovenous graft Orthopedics surgical technologist as it 2. Embolectomy/thrombectomy Reading assignment: relates to those procedures 3. Carotid endarterectomy Fuller, P 836-869 of the peripheral vascular 4. Bypass grafting Instruments, P 231-247 system. - femoral - popliteal – tibial - aorto - iliac – femoral Recommended Reading: 5. Repair of aneurysms Goldman, Maxine A., Pocket - aortic Guide to the Operating Room - other - endovascular 6. Inferior vena cava filters 7. Sympathectomy 8. Amputations

UNIT 7 Thoracic Surgery Learner Objectives Content/Lecture Discussion Related Learner Assignments and Experiences Evaluation Due Dates Upon completion of the unit 1. Closed Procedures WEEK 7 Mon. 04/30 the student will be able to: - bronchoscopy Mon. 04/30 – Wed. 05/02 EXAM # 5 - mediastinoscopy Vascular - thorocoscopy Reading assignment: 7 1. Discuss the role of the - insertion of chest tubes Fuller, P 870-891 surgical technologist as it Instruments, P 231-247 Terminology QUIZ # 6 relates to thoracic surgery. 2. Open Procedures Vascular - scalene node biopdy Recommended Reading: - thorocoplasty Goldman, Maxine A., Pocket - thorocotomy Guide to the Operating Room - lung biopsy/wedge resection - pneumonectomy - decortication of lung - pericardial window

UNIT 8 Cardiac Surgery Learner Objectives Content/Lecture Discussion Related Learner Assignments and Experiences Evaluation Due Dates Upon completion of the 1. Pacemaker/automatic WEEK 8 Mon. 05/07 unit the student will be implantable cardiac defibrillator Mon. 05/07 – Wed. 05/09 Terminology QUIZ # 7 able to: (AICD) Thoracic Surgery 1. Discuss the role of the 2. Intra-aortic balloon insertion Reading assignments: surgical technologist as it 3. Congenital Anomalies Fuller, P 892-929 relates to those - patent ductus arteriosus Instruments, P 231-247 procedures of the eye. - coarctation of the aorta Recommended Reading: - atrial septal defect Goldman, Maxine A., Pocket - ventricular septal defect Guide to the Operating Room - Tetrology of Fallot 5. Acquired lesions ______- Percutaneous transluminal coronary angioplasty (PTCA) - Coronary bypass graft - Valve repair/replacement - Ventricular Aneurysm

UNIT 9 Trauma Learner Objectives Content/Lecture Discussion Related Learner Assignments and Experiences Evaluation Due Dates Upon completion of the WEEK 9 Mon. 05/14 unit the student will be 1. Emergency triage Mon. 05/14– Wed. 05/16 EXAM # 6 able to: - Mechanism of injury. Cardiothoracic Surgery - motor vehicle accidents Reading assignment: 1. Discuss the role of the - falls Fuller, 1020, 1043 Terminology QUIZ # 8 surgical technologist as it - penetrating trauma Instruments, P 231-247 Cardiac relates to trauma. - explosions - thermal Recommended Reading: Goldman, Maxine A., Pocket 2. Describe assessment 2. Assessment Guide to the Operating Room procedures to identify - lab tests correct diagnosis of - diagnostic procedures Handout: diverse types of trauma 3. Multiple operative procedures - Autotransfusion injuries and conditions. 4. Infection - Prioritization of 5. Autotransfusion Emergency Procedures 3. Describe the clinical 6. Evidence Preservation manifestations and 7. Considerations surgical treatment in 8. Surgical Interventions trauma intervention. - subdural hematoma - facial fractures - penetrating eye trauma - rib fractures/flail chest 8 - aortic dissection - myocardial contusion - splenic rupture - liver injury - skeletal injuries

UNIT 10 Emergency Procedures Learner Objectives Content/Lecture Discussion Related Learner Assignments and Experiences Evaluation Due Dates Upon completion of the WEEK 10 Mon. 05/21 unit the student will be 1. Clinical Manifestations Mon. 05/21 – Wed. 05/23 Terminology 1 QUIZ # 9 able to: 2. Management Trauma, Emergency 1.Describe the clinical 3. Prevention manifestations and 4. Equipment Reading assignment: Fuller 6th. ed., management of an 5. Treatment - Responsibilities p 6, anaphylactic reaction. 6. Causes - Disasters p. 71-88, - Staff assignments p. 84, 2.Describe the clinical 1. Cardiopulmonary - The trauma pt. 99-101, manifestations and Resuscitation (CPR) - Crash cart meds 277, management of a techniques. - Emergencies 299-302, hemolytic transfusion - Trauma and debridement reaction Roles and responsibilities 404, emergency settings and 2. Anesthesia. counts 425-426, 3. Describe the clinical 3. Surgeon Handouts: manifestations and 4. Nursing - Outline of anaphylaxis management of a local 5. Surgical Technologist - Outline of transfusion anesthetic toxicity - Local Anesthesia Toxicity reaction. - Procedure for Suctioning - Cardiac Arrest 4. Describe the necessary - Basic Life Support Review equipment for suctioning - Arrest in the Operating and the procedure for Room suctioning the nose and mouth.

5. Describe the clinical manifestations and management of DIC.

6. Describe the clinical manifestations of impending cardiac arrest.

7.Demonstrate competence in Basic Life Support

8.Describe the roles of the perioperative personnel during a cardiac arrest in the OR

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UNIT 11 Organ Transplant/Tissue Donation and Procurement Learner Objectives Content/Lecture Discussion Related Learner Assignments and Experiences Evaluation Due Dates Upon completion of the 1. NYS Regulations WEEK 11 Wed. 05/30 unit the student will be 2. Organ Donor Network Wed. 05/30 EXAM 7 able to: 3. Criteria for donation Trauma, Emergency 1. Discuss the role of the 4. Order of procurement Reading assignment: Procedures, Organ Tissue surgical technologist as it 5. Typical procurement procedures Fuller, P 870-877, 580-582, Donor 500, 830-831 relates to organ/tissue 6. Transplantation: Terminology 2 QUIZ # 10 donation and - kidney Handouts: Trauma, Emergency procurement. - liver - NYS Legislation related - heart to procurement - lungs - Donor Network Criteria

- cornea - islet cells - skin - bone - tendon

UNIT 12 Learner Objectives Content/Lecture Discussion Related Learner Assignments and Experiences Evaluation Due Dates WEEK 12 FINAL EXAM REVIEW Mon. 06/04

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